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Abstract Background Respiratory rate should be monitored continuously in the post-anaesthesia care unit PACU to avoid any delay in the detection of respiratory depression. Capnometry is the standard of care but in extubated patients requires a nasal cannula or a face mask that may be poorly tolerated or can be dislodged, leading to errors in data acquisition and false alarms. The value of a new non-invasive acoustic monitor in this setting has not been fully investigated.
Both the acoustic monitor and the capnometer were connected to a computer to record one pair of data per second for up to 60 min. The acoustic sensor was well tolerated while the face mask was removed by eight patients, leading to study discontinuation in two patients.
Conclusions In extubated patients, continuous assessment of respiration rate with an acoustic monitor correlated well with capnometry. There was close correlation and reasonable limits of agreement between the two devices.
Approximately million major surgical procedures are performed worldwide each year. Respiratory depression is common during the early postoperative period, especially after extubation and when narcotic analgesics are required for pain management. In extubated patients, end-tidal carbon dioxide concentration assessment requires a nasal cannula or a face mask that may be poorly tolerated or can move, inducing errors in data acquisition and false alarms.
This device analyses respiratory vibrations to detect inspiratory and expiratory flow. The acoustic signal is then converted to continuous, numeric values of respiration rate.
The study is registered at Eudract database A The local ethics committee approved the design of the study and informed consent was obtained from all patients. After general anaesthesia, adult patients admitted to the post-anaesthesia care unit PACU were included after extubation.
Exclusion criteria were failure to tolerate an acoustic sensor or a face mask due to the presence of surgical sutures at points of contact with the device, requirement of non-invasive mechanical ventilation, pregnancy, and patients deprived of their liberty by court or administrative decision.
Patients were continuously monitored with electrocardiography, non-invasive blood pressure, and pulse oximetry per standard of care. Both the acoustic monitor and the capnometer were connected to a computer for recording one pair of data per second for a maximum of 60 min, for subsequent analysis. The acoustic sensor or the face mask was repositioned when the signal was lost.
For the acoustic monitor, the loss of signal is indicated by displaying double dashes instead of a number. Episodes of apnoea, defined as an absence of chest wall movements lasting more than 10 s and determined by clinical observation, were recorded. Events that could interfere with measures speaking, coughing, snoring, moving, sighing, vomiting, moaning, and repeated swallowing were recorded and considered as impacting measurement accuracy of either device if a sudden change of at least 4 bpm for 10 s or more followed the occurrence of the event, without a concomitant change in the readings of the other device.
Actual respiration rate was assessed clinically when the two monitors gave a difference of more than 4 bpm for at least 20 s. Statistical analysis Capnometry was regarded as the reference method of respiration rate assessment and the acoustic device as the method of comparison. Agreement between the reference method and the test method was assessed as described by Bland and Altman. Patients were monitored for their respiration from 16 to 60 min providing a total of 99 pairs of respiratory rate measurements.
Respiratory rates were easily assessed with both instrumental methods and ranged from 6 to 24 bpm. The acoustic sensor was well tolerated but required repositioning 13 times for loss of signal. The face mask was removed by eight patients, leading to study discontinuation for repeated removal in two of them.
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